Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome

Kuhn, Jens; Lenartz, Doris; Jiirgen, K.; Huff, Wolfgang; Lee, Sunhee; Koulousakis, A.; Klosterkoetter, J.; Sturm, Volker

doi:10.1007/s00415-006-0404-8

Cited by 165 publications

(125 citation statements)

References 15 publications

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“…Considering that sustained antidromic activation of corticostriatal fibers by NAc DBS will also suppress orthodromic impulses, OFCstriatal output may be reduced further still. DBS within this circuit has also been effective in the treatment of other disorders, including DBS of the subgenual cingulate gyrus for depression (Mayberg et al, 2005) and DBS of the NAc/internal capsule (Flaherty et al, 2005;Kuhn et al, 2007), thalamus (Visser-Vandewalle et al, 2003), and globus pallidus (Ackermans et al, 2006;Shahed et al, 2007) for Tourette's syndrome, which is often comorbid with OCD (Jankovic, 2001). Therefore, by altering the balance of excitation/inhibition within cortical efferent pathways, DBS may prove to have a more general effect of stabilizing disordered systems in a manner that may be generally applicable to patients exhibiting functional deficits within these circuits.…”

Section: Discussionmentioning

confidence: 99%

High-Frequency Deep Brain Stimulation of the Nucleus Accumbens Region Suppresses Neuronal Activity and Selectively Modulates Afferent Drive in Rat Orbitofrontal CortexIn Vivo

McCracken

Grace²

2007

J. Neurosci.

177

131

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High-frequency deep-brain stimulation (DBS) of the nucleus accumbens (NAc) region is an effective therapeutic avenue for patients with treatment-resistant obsessive-compulsive disorder (OCD). Imaging studies suggest that DBS acts by suppressing the aberrant metabolism in the orbitofrontal cortex (OFC) that is a hallmark of OCD; however, little is known about the mechanisms by which this occurs. We examined the effects of 30 min NAc DBS at 130 Hz on spontaneously active OFC neurons and local field potentials (LFPs) in addition to evoked responses elicited by single-pulse stimulation of the NAc or mediodorsal thalamus (MD) in urethane-anesthetized rats. NAc DBS reduced the mean firing rate of OFC neurons, although neurons receiving monosynaptic input from MD were less affected and some putative interneurons were excited by DBS. Single-pulse stimulation of the NAc produced a robust inhibition in OFC neurons that was attenuated after DBS, whereas excitatory responses were unchanged. In contrast, after DBS inhibitory responses evoked from MD were unchanged, whereas excitatory responses were enhanced. NAc-evoked LFP responses were potentiated after DBS, whereas MD-evoked LFP responses were unchanged. NAc DBS also enhanced OFC spontaneous LFP oscillatory activity in the slow (0.5-4 Hz) frequency band. These results suggest that DBS of the NAc region may alleviate OCD symptoms by reducing activity in subsets of OFC neurons, potentially by driving recurrent inhibition though antidromic activation of corticostriatal axon collaterals. Moreover, selective potentiation of input to these inhibitory circuits may also contribute to the therapeutic effects produced by DBS in OCD patients.

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Section: Discussionmentioning

confidence: 99%

High-Frequency Deep Brain Stimulation of the Nucleus Accumbens Region Suppresses Neuronal Activity and Selectively Modulates Afferent Drive in Rat Orbitofrontal CortexIn Vivo

McCracken

Grace²

2007

J. Neurosci.

177

131

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“…110,294 Adverse events related to stimulation included bradykinesia, 55 and reports of infective or hardware-related complications were similar to those seen in patients with thalamic stimulation. 185,259 Other targets investigated for DBS to treat TS include the ALIC/NAcc 68,152,208,307 and STN. 185 Results range from a 20% worsening in tic severity 38 to near abolition of tic behavior.…”

Section: Globus Pallidusmentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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“…17 These latter targets are most consistent with the target used in our patient. In reviewing the stimulation parameters in cases of nucleus accumbens and anterior internal capsule stimulation, we found initial voltages ranging from 4 to 7 V. 7,14,17 The juxtaposed anatomy of the anterior limb of the internal capsule, nucleus accumbens, and VC/VS allows targeting of this area to modulate connections considered relevant to both OCD and TS. Successful intervention at these locations is consistent with the disruption of orbitofrontal-caudate-pallidal-thalamic circuitry, implicated as a source of possible hyperactivity contributing to OCD and TS symptoms.…”

mentioning

confidence: 97%

“…Multiple targets have been successful on a case-by-case basis, with the largest number of patients treated with bilateral implantation in the centromedian-parafascicular complex and ventralis oralis of the thalamus. 21 Other DBS targets, including the internal segment of the globus pallidus, 5,6,16 anterior limb of the internal capsule, 7,14 and nucleus accumbens, 14,17 have demonstrated a successful reduction in tic severity and comorbid obsessive-compulsive symptoms, a common clinical finding in patients with TS. 15 A reported case of TS with severe comorbid OCD and self-mutilation responded dramatically to DBS in the nucleus accumbens.…”

mentioning

confidence: 99%

Deep brain stimulation for the obsessive-compulsive and Tourette-like symptoms of Kleefstra syndrome

Segar

Chodakiewitz

Torabi

et al. 2015

FOC

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Deep brain stimulation (DBS) has been reported to have beneficial effects in severe, treatment-refractory cases of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). In this report, the authors present the first case in which DBS was used to treat the neuropsychiatric symptoms of Kleefstra syndrome, a rare genetic disorder characterized by childhood hypotonia, intellectual disability, distinctive facial features, and myriad psychiatric and behavioral disturbances. A 24-year-old female patient with childhood hypotonia, developmental delay, and diagnoses of autism spectrum disorder, OCD, and TS refractory to medical management underwent the placement of bilateral ventral capsule/ventral striatum (VC/VS) DBS leads, with clinical improvement. Medical providers and family observed gradual and progressive improvement in the patient's compulsive behaviors, coprolalia, speech, and social interaction. Symptoms recurred when both DBS electrodes failed because of lead fracture and dislodgement, although the clinical benefits were restored by lead replacement. The symptomatic and functional improvements observed in this case of VC/VS DBS for Kleefstra syndrome suggest a novel indication for DBS worthy of further investigation.

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Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome

Cited by 165 publications

References 15 publications

High-Frequency Deep Brain Stimulation of the Nucleus Accumbens Region Suppresses Neuronal Activity and Selectively Modulates Afferent Drive in Rat Orbitofrontal CortexIn Vivo

High-Frequency Deep Brain Stimulation of the Nucleus Accumbens Region Suppresses Neuronal Activity and Selectively Modulates Afferent Drive in Rat Orbitofrontal CortexIn Vivo

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation for the obsessive-compulsive and Tourette-like symptoms of Kleefstra syndrome

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